Publications by authors named "Paolo Machi"

44 Publications

Single-hole, ruptured parenchymal arteriovenous fistula of the mesencephalon: not known vascular malformation of the brain or a posthemorrhagic entity?

Ideggyogy Sz 2021 Mar;74(3-4):126-128

Neuroradiology Division, Department of Radiology and Medical Informatics, Geneva University Hospitals, Geneva, Switzerland.

The subtypes of brain arteriovenous malformations, with direct, single-hole fistulas without co-existing nidus are not described as existing entities inside the brain parenchyma but on the pial surface. True parenchymal arteriovenous malformations present with nidal structure, even if they are small, whereas surface lesions may present a direct fistulous configuration. In this case of midbrain haemorrhage a direct arteriovenous fistula was detected at the level of the red nucleus between a paramedian midbrain perforator artery and a paramedian parenchymal vein, with pseudo-aneurysm formation at the fistulous connection, without signs of adjacent nidus structure. The hypothesis whether a pre-existing arteriovenous fistula ruptured or a spontaneous haemorrhage has caused the fistulous connection is discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.18071/isz.74.0126DOI Listing
March 2021

Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic.

Stroke Vasc Neurol 2021 Mar 26. Epub 2021 Mar 26.

Department of Radiology, Beaumont Hospital, Dublin, Ireland.

Background: During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study's objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines.

Methods: We conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March-31 May 2020. The prior 1-year control period (1 March-31 May 2019) was obtained to account for seasonal variation.

Findings: There was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI -24.3% to -20.7%, p<0.0001). Embolisation of ruptured aneurysms declined with 1170-1035 procedures, respectively, representing an 11.5% (95%CI -13.5% to -9.8%, p=0.002) relative drop. Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations, a 24.9% relative decline (95% CI -28.0% to -22.1%, p<0.0001). A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1% (95% CI 32.3% to 50.6%, p=0.008) despite a decrease in SAH admissions in this tertile.

Interpretation: There was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/svn-2020-000695DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006491PMC
March 2021

Cerebrovascular Complications and Vessel Wall Imaging in COVID-19 Encephalopathy-A Pilot Study.

Clin Neuroradiol 2021 Mar 26. Epub 2021 Mar 26.

Division of Neuroradiology, Diagnostic Department, Geneva University Hospitals, 1211, Geneva, Switzerland.

Background And Purpose: Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with several complications of the central nervous system (CNS), including acute encephalopathy.

Methods: In this pilot study, we report a series of 39 patients (66.5 ± 9.2 years; 10.3% female) with acute encephalopathy, who underwent a standard brain magnetic resonance imaging (MRI) at 1.5 T during the acute symptomatic phase. In addition to diffusion-weighted imaging, MR angiography and susceptibility-weighted images, high-resolution vascular black blood sequences (in 34 cases) were used to investigate the vasculature of the brain.

Results: In 29 out of 34 patients with COVID-19 encephalopathy (85%) with high-resolution vessel wall imaging, we found a circular enhancement and thickening of the basilar and vertebral arteries, without any correlation with ischemia or microbleeds (reported in 21% and 59%, respectively).

Conclusion: We report a high prevalence of vascular changes suggestive of endotheliitis as reported in other organs. This could suggest an inflammatory mechanism underlying this encephalopathy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00062-021-01008-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7995679PMC
March 2021

Global Impact of COVID-19 on Stroke Care and Intravenous Thrombolysis.

Neurology 2021 Mar 25. Epub 2021 Mar 25.

Department of Neurology, University of North Carolina at Chapel Hill, North Carolina, USA.

Objective: The objectives of this study were to measure the global impact of the pandemic on the volumes for intravenous thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with two control 4-month periods.

Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes and/or classifications in stroke databases.

Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95%CI, -11.7 to - 11.3, p<0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95%CI, -13.8 to -12.7, p<0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95%CI, -13.7 to -10.3, p=0.001). Recovery of stroke hospitalization volume (9.5%, 95%CI 9.2-9.8, p<0.0001) was noted over the two later (May, June) versus the two earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.3% (1,722/52,026) of all stroke admissions.

Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1212/WNL.0000000000011885DOI Listing
March 2021

Experimental evaluation of direct thromboaspiration efficacy according to the angle of interaction between the aspiration catheter and the clot.

J Neurointerv Surg 2021 Jan 22. Epub 2021 Jan 22.

Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland.

Background: Successful direct thromboaspiration (DTA) is related to several factors such as clot consistency, size, and location. It has also been demonstrated recently that the angle of interaction (AOI) formed by the aspiration catheter and the clot is related to DTA efficacy. The aims of this study were three-fold: (a) to confirm the clinical finding that the AOI formed by the aspiration catheter and the clot influence DTA efficacy; (b) to evaluate to what extent this influence varies according to differences in clot consistency and size; and (c) to validate stent retriever thrombectomy as an effective rescue treatment after DTA failure in the presence of an unfavorable AOI.

Methods: A rigid vascular phantom designed to reproduce a middle cerebral artery trifurcation anatomy with three M2 segments forming different angles with M1 and thrombus analog of different consistencies and sizes was used.

Results: DTA was highly effective for AOIs >125.5°, irrespective of thrombus analog features. However, its efficacy decreased for acute AOIs. Rescue stent retriever thrombectomy was effective in 92.6% of cases of DTA failure.

Conclusions: This in vitro study confirmed that the AOI formed by the aspiration catheter and the thrombus analog influenced DTA efficacy, with an AOI >125.5° related to an effective DTA. Stent retriever thrombectomy was an effective rescue treatment after DTA failure, even in the presence of an unfavorable AOI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/neurintsurg-2020-016889DOI Listing
January 2021

Global impact of COVID-19 on stroke care.

Int J Stroke 2021 Mar 29:1747493021991652. Epub 2021 Mar 29.

Neurology, Grady Memorial Hospital, Emory University, Atlanta, Georgia, USA.

Background: The COVID-19 pandemic led to profound changes in the organization of health care systems worldwide.

Aims: We sought to measure the global impact of the COVID-19 pandemic on the volumes for mechanical thrombectomy, stroke, and intracranial hemorrhage hospitalizations over a three-month period at the height of the pandemic (1 March-31 May 2020) compared with two control three-month periods (immediately preceding and one year prior).

Methods: Retrospective, observational, international study, across 6 continents, 40 countries, and 187 comprehensive stroke centers. The diagnoses were identified by their ICD-10 codes and/or classifications in stroke databases at participating centers.

Results: The hospitalization volumes for any stroke, intracranial hemorrhage, and mechanical thrombectomy were 26,699, 4002, and 5191 in the three months immediately before versus 21,576, 3540, and 4533 during the first three pandemic months, representing declines of 19.2% (95%CI, -19.7 to -18.7), 11.5% (95%CI, -12.6 to -10.6), and 12.7% (95%CI, -13.6 to -11.8), respectively. The decreases were noted across centers with high, mid, and low COVID-19 hospitalization burden, and also across high, mid, and low volume stroke/mechanical thrombectomy centers. High-volume COVID-19 centers (-20.5%) had greater declines in mechanical thrombectomy volumes than mid- (-10.1%) and low-volume (-8.7%) centers (p < 0.0001). There was a 1.5% stroke rate across 54,366 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.9% (784/20,250) of all stroke admissions.

Conclusion: The COVID-19 pandemic was associated with a global decline in the volume of overall stroke hospitalizations, mechanical thrombectomy procedures, and intracranial hemorrhage admission volumes. Despite geographic variations, these volume reductions were observed regardless of COVID-19 hospitalization burden and pre-pandemic stroke/mechanical thrombectomy volumes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1747493021991652DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010375PMC
March 2021

Endovascular treatment of acute ischemic stroke.

J Neurosurg Sci 2020 Nov 27. Epub 2020 Nov 27.

Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland -

Endovascular treatment of acute ischemic stroke has become the first choice of treatment in large cerebral vessel occlusions, with a very high efficacy in terms of revascularization and reducing disability of affected patients. Revolutionizing acute therapy, it induced important paradigm shifts in the concepts of time and salvageable brain. In this review we focus on the current concepts of patient selection, imaging, techniques and perspectives of endovascular stroke treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.23736/S0390-5616.20.05109-7DOI Listing
November 2020

Acute Stroke Management During the COVID-19 Pandemic: Does Confinement Impact Eligibility for Endovascular Therapy?

Stroke 2020 08 1;51(8):2593-2596. Epub 2020 Jul 1.

Departments of Neurology and Neuroradiology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (J.P.M., J.N.R.).

During the coronavirus disease 2019 (COVID-19) pandemic, the World Health Organization recommended measures to mitigate the outbreak such as social distancing and confinement. Since these measures have been put in place, anecdotal reports describe a decrease in the number of endovascular therapy (EVT) treatments for acute ischemic stroke due to large vessel occlusion. The purpose of our study was to determine the effect on EVT for patients with acute ischemic stroke during the COVID-19 confinement. In this retrospective, observational study, data were collected from November 1, 2019, to April 15, 2020, at 17 stroke centers in countries where confinement measures have been in place since March 2020 for the COVID-19 pandemic (Switzerland, Italy, France, Spain, Portugal, Germany, Canada, and United States). This study included 1600 patients treated by EVT for acute ischemic stroke. Date of EVT and symptom onset-to-groin puncture time were collected. Mean number of EVTs performed per hospital per 2-week interval and mean stroke onset-to-groin puncture time were calculated before confinement measures and after confinement measures. Distributions (non-normal) between the 2 groups (before COVID-19 confinement versus after COVID-19 confinement) were compared using 2-sample Wilcoxon rank-sum test. The results show a significant decrease in mean number of EVTs performed per hospital per 2-week interval between before COVID-19 confinement (9.0 [95% CI, 7.8-10.1]) and after COVID-19 confinement (6.1 [95% CI, 4.5-7.7]), (<0.001). In addition, there is a significant increase in mean stroke onset-to-groin puncture time (<0.001), between before COVID-19 confinement (300.3 minutes [95% CI, 285.3-315.4]) and after COVID-19 confinement (354.5 minutes [95% CI, 316.2-392.7]). Our preliminary analysis indicates a 32% reduction in EVT procedures and an estimated 54-minute increase in symptom onset-to-groin puncture time after confinement measures for COVID-19 pandemic were put into place.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/STROKEAHA.120.030794DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7340133PMC
August 2020

Clot-Based Radiomics Predict a Mechanical Thrombectomy Strategy for Successful Recanalization in Acute Ischemic Stroke.

Stroke 2020 08 20;51(8):2488-2494. Epub 2020 Jul 20.

Diagnostic and Interventional Neuroradiology Unit, Department of Diagnostic (G.B., A.R., M.I.V., K.-O.L., P.M.), Geneva University Hospitals, Switzerland.

Background And Purpose: Mechanical thrombectomy (MTB) is a reference treatment for acute ischemic stroke, with several endovascular strategies currently available. However, no quantitative methods are available for the selection of the best endovascular strategy or to predict the difficulty of clot removal. We aimed to investigate the predictive value of an endovascular strategy based on radiomic features extracted from the clot on preinterventional, noncontrast computed tomography to identify patients with first-attempt recanalization with thromboaspiration and to predict the overall number of passages needed with an MTB device for successful recanalization.

Methods: We performed a study including 2 cohorts of patients admitted to our hospital: a retrospective training cohort (n=109) and a prospective validation cohort (n=47). Thrombi were segmented on noncontrast computed tomography, followed by the automatic computation of 1485 thrombus-related radiomic features. After selection of the relevant features, 2 machine learning models were developed on the training cohort to predict (1) first-attempt recanalization with thromboaspiration and (2) the overall number of passages with MTB devices for successful recanalization. The performance of the models was evaluated on the prospective validation cohort.

Results: A small subset of radiomic features (n=9) was predictive of first-attempt recanalization with thromboaspiration (receiver operating characteristic curve-area under the curve, 0.88). The same subset also predicted the overall number of passages required for successful recanalization (explained variance, 0.70; mean squared error, 0.76; Pearson correlation coefficient, 0.73; <0.05).

Conclusions: Clot-based radiomics have the ability to predict an MTB strategy for successful recanalization in acute ischemic stroke, thus allowing a potentially better selection of the MTB strategy, as well as patients who are most likely to benefit from the intervention.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/STROKEAHA.120.030334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7382538PMC
August 2020

Integrating regional perfusion CT information to improve prediction of infarction after stroke.

J Cereb Blood Flow Metab 2021 Mar 5;41(3):502-510. Epub 2020 Jun 5.

Stroke Research Group, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva, Switzerland.

Physiological evidence suggests that neighboring brain regions have similar perfusion characteristics (vascular supply, collateral blood flow). It is largely unknown whether integrating perfusion CT (pCT) information from the area surrounding a given voxel (i.e. the receptive field (RF)) improves the prediction of infarction of this voxel. Based on general linear regression models (GLMs) and using acute pCT-derived maps, we compared the added value of cuboid RF to predict the final infarct. To this aim, we included 144 stroke patients with acute pCT and follow-up MRI, used to delineate the final infarct. Overall, the performance of GLMs to predict the final infarct improved when using RF for all pCT maps (cerebral blood flow, cerebral blood volume, mean transit time and time-to-maximum of the tissue residual function (Tmax)). The highest performance was obtained with Tmax (glm(Tmax); AUC = 0.89 ± 0.03 with RF vs. 0.78 ± 0.02 without RF;  < 0.001) and with a model combining all perfusion parameters (glm(multi); AUC 0.89 ± 0.02 with RF vs. 0.79 ± 0.02 without RF;  < 0.001). These results suggest that prediction of infarction improves by integrating perfusion information from adjacent tissue. This approach may be applied in future studies to better identify ischemic core and penumbra thresholds and improve patient selection for acute stroke treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0271678X20924549DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7922756PMC
March 2021

Thoracic aggressive vertebral hemangiomas: multidisciplinary management in a hybrid room.

Eur Spine J 2020 12 10;29(12):3179-3186. Epub 2020 Apr 10.

Spine Unit, Département Des Neurosciences Cliniques, Service de Neurochirurgie, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.

Purpose: Vertebral hemangiomas (VH) account for 2-3% of all spinal tumors. The majority is incidentally found on radiographic studies: 1% present with pain and/or neurologic deficits. We report our experience with the multidisciplinary management of aggressive symptomatic thoracic VH by concomitant intraoperative sclerotization with sodium tetradecyl sulfate (STS), vertebroplasty, posterior decompression (with/without fusion) and surgical resection in a hybrid operating room (HR) equipped with a rotational scanner and a radiolucent operating table.

Methods: Patients admitted with aggressive spinal VH between 2007 and 2018 were included. Data regarding demographics, presenting symptoms, location of the lesion, preoperative embolization, length of the surgery, estimated blood loss (EBL) as well as follow-up (FU) were retrieved.

Results: Five patients were included (three females, mean age 65 years; range 59-75). Three patients presented with a myelopathy and two mechanical thoracic pain. All patients underwent a single-stage percutaneous sclerotization and vertebroplasty followed by a surgical decompression associated with epidural intralesional injection of STS and subtotal resection of the epidural lesion. Two patients had preoperative embolization. Mean procedural duration was 338 min (range 210-480 min). Four patients had marginal EBL, one patient had 500 ml EBL. Patients had no evidence of lesion recurrence or progression at the end of the follow-up.

Conclusions: The single-stage multimodal management of aggressive symptomatic VH is safe and effective. It allows for a direct intraoperative sclerotherapy combined with maximal tumor resection, resulting in reduced blood loss. The use of STS as a direct intraoperative sclerotizing agent is safe and reliable.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00586-020-06404-9DOI Listing
December 2020

Overview of Different Flow Diverters and Flow Dynamics.

Neurosurgery 2020 01;86(Suppl 1):S21-S34

Department of Medical Imaging, Toronto Western Hospital and St. Michael's Hospital, University of Toronto, Toronto, Canada.

Over the past decade, flow diverter technology for endocranial aneurysms has seen rapid evolution, with the development of new devices quickly outpacing the clinical evidence base. However, flow diversion has not yet been directly compared to surgical aneurysm clipping or other endovascular procedures. The oldest and most well-studied device is the Pipeline Embolization Device (PED; Medtronic), recently transitioned to the Pipeline Flex (Medtronic), which still has sparse data regarding outcomes. To date, other flow diverting devices have not been shown to outperform the PED, although information comes primarily from retrospective studies with short follow-up, which are not always comparable. Because of this lack of high-quality outcome data, no reliable recommendations can be made for choosing among flow diversion devices yet. Moreover, the decision to proceed with flow diversion should be individualized to each patient. In this work, we wish to provide a comprehensive overview of the technical specifications of all flow diverter devices currently available, accompanied by a succinct description of the evidence base surrounding each device.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/neuros/nyz323DOI Listing
January 2020

Posterior Fossa Arteriovenous Malformations: Experience with 14 Patients and a Systematic Review of the Literature.

J Neurol Surg A Cent Eur Neurosurg 2020 Mar 28;81(2):170-176. Epub 2019 Oct 28.

Department of Neurosurgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland.

Background:  The optimal management of posterior fossa arteriovenous malformations (pfAVMs) is a matter of debate. To advance this discussion, we present our clinical series and the results of a systematic literature review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.

Methods:  Fourteen consecutive patients with pfAVMs were admitted between 2007 and 2018. Preoperative status, radiologic parameters, and outcome were assessed. A systematic literature review was performed according to the PRISMA-P guidelines.

Results:  Ten patients presented with rupture (71%), of whom three had associated aneurysms (AAs). The treatments were microsurgery ( = 4), endovascular ( = 3), radiosurgery ( = 2), a combination of two or three treatment modalities ( = 3), or conservative ( = 2). At discharge, all four patients (100%) with unruptured pfAVMs had a good outcome (modified Rankin Scale [mRS]: 0-2). In contrast, in ruptured pfAVM cases, mRS was 0 to 2 in four patients (40%), mRS 3 to 4 in two (20%), mRS 5 in three (30%), and one patient (10%) died within 30 days after gamma knife treatment due to pancreatitis secondary to chronic alcohol abuse. At discharge, four patients (29%) had persistent preinterventional cranial nerve and/or focal neurologic deficits. The literature review identified 63 articles with 1,753 pfAVM patients. Overall, 66% of pfAVMs presented with rupture, and AAs were found in 20% of the cases, which is higher than in supratentorial AVMs (stAVMs).

Conclusions:  Because pfAVMs are associated with higher rates of hemorrhagic presentation, higher rates of morbidity and mortality when ruptured, and have a higher incidence of AAs compared with stAVMs, early curative treatment is recommended as soon as the diagnosis is established, regardless of rupture status.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0039-1691820DOI Listing
March 2020

Imaging Clot Characteristics in Stroke and its Possible Implication on Treatment.

Clin Neuroradiol 2020 Mar 10;30(1):27-35. Epub 2019 Oct 10.

Université de Genève, Medecine, 1211, Geneva, Switzerland.

Ischemic cerebral stroke is an increasingly treatable entity due to the recent developments in intravascular clot extraction, with recent research indicating that the efficacy of the chosen thrombectomy device may be affected by the composition of the occluding clot. This literature review summarizes the results from analytical clot imaging studies, and in vitro and in vivo thrombectomies, to assess whether the choice of thrombectomy device can be optimized to the composition of the occluding clot. The literature has shown that the composition of the clot impacts its mechanical properties and interactions with the device. The existing literature with respect to imaging and current results is discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00062-019-00841-wDOI Listing
March 2020

Direct thromboaspiration efficacy for mechanical thrombectomy is related to the angle of interaction between the aspiration catheter and the clot.

J Neurointerv Surg 2020 Apr 23;12(4):396-400. Epub 2019 Sep 23.

Neuroradiology, University Hospitals of Geneva, Geneva, Switzerland.

Background: Direct thromboaspiration has been reported as an effective mechanical treatment for acute ischemic stroke. We aimed to determine whether the angle of interaction between the aspiration catheter and the clot affects the success of clot removal in ischemic stroke patients with large vessel occlusion in the anterior and posterior circulation.

Methods: All patients treated at our institution by direct thromboaspiration as a firstline technique between January 2016 and December 2017 were enrolled in the study. We retrospectively reviewed baseline and procedural characteristics, the angle of interaction formed between the aspiration catheter and the clot, the modified Thrombolysis in Cerebral Infarction score, and the 3 month modified Rankin Scale score.

Results: 85 patients underwent direct thromboaspiration as the firstline treatment during the study period. 100 direct thromboaspiration passes were performed. An angle of interaction of ≥125.5° significantly influenced the success of clot removal (P<0.001) with good sensitivity and specificity, in particular for occlusion of the middle cerebral and basilar artery. The combination of aspiration with a stent retriever based thrombectomy was a valid rescue treatment in cases of standalone direct thromboaspiration failure.

Conclusions: In our series, an angle of interaction between the aspiration catheter and the clot of ≥125.5° was significantly associated with successful clot removal. The prediction of the angle of interaction on pretreatment imaging may help operators to select the most adequate mechanical thrombectomy technique on a case by case basis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/neurintsurg-2019-015113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146918PMC
April 2020

Ruptured PICA aneurysms: presentation and treatment outcomes compared to other posterior circulation aneurysms. A Swiss SOS study.

Acta Neurochir (Wien) 2019 07 26;161(7):1325-1334. Epub 2019 Apr 26.

Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland.

Background And Purpose: Aneurysms of the posterior inferior cerebellar artery (PICA) are relatively uncommon and evidence is sparse about patients presenting with ruptured PICA aneurysms. We performed an analysis of the Swiss SOS national registry to describe clinical presentation, treatment pattern, and neurological outcome of patients with ruptured PICA aneurysms compared with other ruptured posterior circulation (PC) aneurysms.

Methods: This was a retrospective analysis of anonymized data from the Swiss SOS registry (Swiss Study on Aneurysmal Subarachnoid Hemorrhage; 2009-2014). Patients with ruptured PC aneurysms were subdivided into a PICA and non-PICA group. Clinical, radiological, and treatment-related variables were identified, and their impact on the neurological outcome was determined in terms of modified Rankin score at discharge and at 1 year of follow-up for the two groups.

Results: Data from 1864 aneurysmal subarachnoid hemorrhage patients were reviewed. There were 264 patients with a ruptured PC aneurysm. Seventy-four PICA aneurysms represented 28% of the series; clinical and radiological characteristics at admission were comparable between the PICA and non-PICA group. Surgical treatment was accomplished in 28% of patients in the PICA group and in the 4.8% of patients in the non-PICA group. No statistically significant difference was found between the two groups in terms of complications after treatment. Hydrocephalus requiring definitive shunt was needed in 21.6% of PICA patients (p = 0.6); cranial nerve deficit was present in average a quarter of the patients in both PICA and non-PICA group with no statistical difference (p = 0.3). A more favorable outcome (66.2%) was reported in the PICA group at discharge (p < 0.05) but this difference faded over time with a similar neurological outcome at 1-year follow-up (p = 0.09) between both PICA and non-PICA group. The Kaplan-Meyer estimation showed no significant difference in the mortality rate between both groups (p = 0.08).

Conclusions: In the present study, patients with ruptured PICA aneurysms had a favorable neurological outcome in more than two thirds of cases, similar to patients with other ruptured PC aneurysms. Surgical treatment remains a valid option in a third of cases with ruptured PICA aneurysms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00701-019-03894-5DOI Listing
July 2019

Ruptured posterior circulation aneurysms: epidemiology, patterns of care, and outcomes from the Swiss SOS national registry.

Acta Neurochir (Wien) 2019 04 25;161(4):769-779. Epub 2019 Jan 25.

Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland.

Background: The treatment of ruptured posterior circulation aneurysms remains challenging despite progresses in the endovascular and neurosurgical techniques.

Objective: To provide epidemiological characterization of subjects presenting with ruptured posterior circulation aneurysms in Switzerland and thereby assessing the treatment patterns and neurological outcomes.

Methods: This is a retrospective analysis of the Swiss SOS registry for patients with aneurysmal subarachnoid hemorrhage. Patients were divided in 3 groups (upper, lower, and middle third) according to aneurysm location. Clinical, radiological, and treatment-related variables were identified and their impact on the neurological outcome was determined.

Results: From 2009 to 2014, we included 264 patients with ruptured posterior circulation aneurysms. Endovascular occlusion was the most common treatment in all 3 groups (72% in the upper third, 68% in the middle third, and 58.8% in the lower third). Surgical treatment was performed in 11.3%. Favorable outcome (mRS ≤ 3) was found in 56% at discharge and 65.7% at 1 year. No significant difference in the neurological outcome were found among the three groups, in terms of mRS at discharge (p = 0.20) and at 1 year (p = 0.18). High WFNS grade, high Fisher grade at presentation, and rebleeding before aneurysm occlusion (p = 0.001) were all correlated with the risk of unfavorable neurological outcome (or death) at discharge and at 1 year.

Conclusions: In this study, endovascular occlusion was the principal treatment, with a favorable outcome for two-thirds of patients at discharge and at long term. These results are similar to high volume neurovascular centers worldwide, reflecting the importance of centralized care at specialized neurovascular centers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00701-019-03812-9DOI Listing
April 2019

Solitaire FR thrombectomy system: immediate results in 56 consecutive acute ischemic stroke patients.

J Neurointerv Surg 2018 Jul;10(Suppl 1):i27-i32

Department of Neuroradiology, Montpellier University Hospital, Montpellier, France.

Background And Purpose: Prompt recanalization of cerebral arteries in patients diagnosed with acute ischemic stroke is known to be associated with a better clinical outcome. The aim of this study was to present our initial experience regarding the efficacy and safety of the Solitaire FR as a revascularization device.

Methods: 56 consecutive patients presenting with acute ischemic stroke underwent intra-arterial therapy using the Solitaire FR revascularization device. Immediate angiographic results and early clinical outcomes are presented.

Results: Solitaire FR was successful in achieving recanalization in 50 out of 56 patients (89%) with a final Thrombolysis in Cerebral Infarction score ≥2b. Five out of 56 patients had procedure related complications: two asymptomatic subarachnoid hemorrhages, two thromboembolic events and one symptomatic intracranial hemorrhage (PH2). Thirty patients (53.5%) demonstrated at discharge a National Institutes of Health Stroke Scale Score of ≤1 or an improvement of at least 10 points from baseline, and 26 patients (46%) had a modified Rankin Score ≤2.

Conclusions: Solitaire FR is successful in achieving a high rate of arterial recanalization with a low complication rate. The Solitaire FR is a promising thrombectomy tool with a high degree of effectiveness, safety and ease of use.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/jnis.2010.004051.repDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6241203PMC
July 2018

Neurovascular stent artifacts in 3D-TOF and 3D-PCMRI: Influence of stent design on flow measurement.

Magn Reson Med 2019 01 12;81(1):560-572. Epub 2018 Jun 12.

Departement of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland.

Purpose: The morphological and hemodynamic evaluations of neurovascular diseases treated with stents would benefit from noninvasive imaging techniques such as 3D time-of-flight MRI (3D-TOF) and 3D phase contrast MRI (3D-PCMRI). For this purpose, a comprehensive evaluation of the stent artifacts and their impact on the flow measurement is critical.

Methods: The artifacts of a representative sample of neurovascular stents were evaluated in vitro with 3D-TOF and 3D-PCMRI sequences. The dependency of the artifacts with respect to the orientation was analyzed for each stent design as well as the impact on the flow measurement accuracy. Furthermore, the 3D-PCMRI data of four patients carrying intracranial aneurysms treated with flow diverter stents were analyzed as illustrative examples.

Results: The stent artifacts were mainly confined to the stent lumen therefore indicating the leading role of shielding effect. The influence of the stent design and its orientation with respect to the transmitting MR coils were highlighted. The artifacts impacted the 3D-PCMRI velocities mainly in the low magnitude domains, which were discarded from the analysis ensuring reliable near-stent velocities. The feasibility of in-stent flow measurements was confirmed in vivo on two patients who showed strong correlation between flow and geometric features. In two other patients, the consistency of out-of-stent velocities was verified qualitatively through intra-aneurysmal streamlines except when susceptibility artifacts occurred.

Conclusion: The present results motivate the conception of low inductance or nonconductive stent design. Furthermore, the feasibility of near-stent 3D-PCMRI measurements opens the door to clinical applications like the post-treatment follow-up of stenoses or intracranial aneurysms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/mrm.27352DOI Listing
January 2019

Virtual stenting of intracranial aneurysms: A pilot study for the prediction of treatment success based on hemodynamic simulations.

Int J Artif Organs 2018 Nov 21;41(11):698-705. Epub 2018 May 21.

5 Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.

Endovascular treatment of intracranial aneurysms using flow-diverting devices has revolutionized the treatment of large and complex lesions due to its minimally invasive nature and potential clinical outcomes. However, incomplete or delayed occlusion and persistent intracranial aneurysm growth are still an issue for up to one-third of the patients. We evaluated two patients with intracranial aneurysm located at the internal carotid artery who were treated with flow-diverting devices and had opposite outcomes. Both patients presented with similar aneurysms and were treated with the same device, but after a 1-year follow-up, one case presented with complete occlusion (Case 1) and the other required further treatment (Case 2). To reproduce the interventions, virtual stents were deployed and blood flow simulations were carried out using the respective patient-specific geometries. Afterward, hemodynamic metrics such as aneurysmal inflow reduction, wall shear stresses, oscillatory shear, and inflow concentration indices were quantified. The hemodynamic simulations reveal that for both cases, the neck inflow was clearly reduced due to the therapy (Case 1: 19%, Case 2: 35%). In addition, relevant hemodynamic parameters such as time-averaged wall shear stress (Case 1: 35.6%, Case 2: 57%) and oscillatory shear (Case 1: 33.1%, Case 2: 26.7%) were decreased considerably. However, although stronger relative reductions occurred in the unsuccessful case, the absolute flow values in the successful case were approximately halved. The findings demonstrate that a high relative effect of endovascular devices is not necessarily associated with the desired treatment outcome. Instead, it appears that a successful intracranial aneurysm therapy requires a certain patient-specific inflow threshold.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0391398818775521DOI Listing
November 2018

Experimental evaluation of the NeVa™ thrombectomy device a novel stent retriever conceived to improve efficacy of organized clot removal.

J Neuroradiol 2019 May 3;46(3):163-167. Epub 2018 Apr 3.

Department of Mechanical Engineering, University of Montpellier, France.

Background And Purpose: Stent retrievers are recognized as the most effective devices for intracranial thrombectomy. Although highly effective, such devices fail in clot removal when the brain vessel occlusion is due to organized, firm clots. The mechanism of failure is that during the retrieval, devices remain compressed by the organized clot and slide between it and the vessel wall without any removal effect. The aim of the current study is to present the preclinical evaluation of the Neva™ device, a novel stent retriever designed to improve the incorporation and removal of organized thrombi.

Materials And Methods: Preclinical evaluation of the Neva™ device was divided in three main chapters: efficacy analysis, mechanical analysis and safety analysis. Efficacy and mechanical analysis aimed to investigate the behavior during the retrieval of the Neva™ device and its interaction with experimental organized clots. Safety analysis was conducted on animals in order to investigate the effect of the Neva™ device on real arteries after simulated thrombectomy maneuvers.

Results: Neva™ device showed a high rate of "optimal clot integration" and "effective clot removal" which was related to constant cohesion to the vessel wall during retrievals. Safety analysis showed as the most frequent finding the disruption of the intima of the tested vessels with, in some cases, minimal disruption of the internal elastic lamina.

Conclusions: The Neva™ device has demonstrated safety and efficacy in a pre-clinical study. Such encouraging, preliminary results have to be compared with those of clinical trials.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.neurad.2018.03.005DOI Listing
May 2019

Second-Generation Hydrogel Coils for the Endovascular Treatment of Intracranial Aneurysms: A Randomized Controlled Trial.

Stroke 2018 03 6;49(3):667-674. Epub 2018 Feb 6.

From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.).

Background And Purpose: Endovascular embolization of intracranial aneurysms with hydrogel-coated coils lowers the risk of major recurrence, but technical limitations (coil stiffness and time restriction for placement) have prevented their wider clinical use. We aimed to assess the efficacy of softer, second-generation hydrogel coils.

Methods: A randomized controlled trial was conducted at 22 centers in France and Germany. Patients aged 18 to 75 years with untreated ruptured or unruptured intracranial aneurysms measuring 4 to 12 mm in diameter were eligible and randomized (1:1 using a web-based system, stratified by rupture status) to coiling with either second-generation hydrogel coils or bare platinum coils. Assist devices were allowed as clinically required. Independent imaging core laboratory was masked to allocation. Primary end point was a composite outcome measure including major aneurysm recurrence, aneurysm retreatment, morbidity that prevented angiographic controls, and any death during treatment and follow-up. Data were analyzed as randomized.

Results: Randomization began on October 15, 2009, and stopped on January 31, 2014, after 513 patients (hydrogel, n=256; bare platinum, n=257); 20 patients were excluded for missing informed consent and 9 for treatment-related criteria. Four hundred eighty-four patients (hydrogel, n=243; bare platinum, n=241) were included in the analysis; 208 (43%) were treated for ruptured aneurysms. Final end point data were available for 456 patients. Forty-five out of 226 (19.9%) patients in the hydrogel group and 66/230 (28.7%) in the control group had an unfavorable composite primary outcome, giving a statistically significant reduction in the proportion of an unfavorable composite primary outcome with hydrogel coils-adjusted for rupture status-of 8.4% (95% confidence interval, 0.5-16.2; =0.036). Adverse and serious adverse events were evenly distributed between groups.

Conclusions: Our results suggest that endovascular coil embolization with second-generation hydrogel coils may reduce the rate of unfavorable outcome events in patients with small- and medium-sized intracranial aneurysms.

Clinical Trial Registration: URL: https://www.drks.de/drks_web/. Unique identifier: DRKS00003132.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/STROKEAHA.117.018707DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839703PMC
March 2018

Trans-venous embolization of a basal ganglia ruptured arteriovenous malformation with open surgical arterial control: A hybrid technique.

J Neuroradiol 2018 May 2;45(3):202-205. Epub 2018 Feb 2.

Neurosurgery Division, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland.

Treatment of ruptured deep-seated arteriovenous malformations is challenging and associated with elevated risks. This is due to the proximity or involvement of critical brain structures and the specifically fine and delicate angioarchitecture of these lesions, making both endovascular and surgical access technically complicated. We present the advantages of a true combined, open surgical and endovascular transvenous approach in a hybrid operating room. The technique may overcome in part the difficulties and may improve safety and risk related concerns.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.neurad.2017.12.021DOI Listing
May 2018

The Catch Mini stent retriever for mechanical thrombectomy in distal intracranial occlusions.

J Neuroradiol 2018 Sep 2;45(5):305-309. Epub 2018 Feb 2.

Service of neuroradiology, university hospital of Geneva, Geneva, Switzerland. Electronic address:

Objective: Mechanical thrombectomy (MTB) is a treatment of reference for acute ischemic stroke due to large brain vessel occlusion but some concerns remain about its use in small distal branches. In the present study, we assessed the efficacy and the safety of distal MTB using the Catch Mini (CM) stent retriever.

Methods: We retrospectively reviewed a prospectively maintained database of all consecutive patients who underwent MTB for a distal intracranial occlusion with the Catch Mini device at our hospital.

Results: Forty-one patient underwent MTB for distal intracranial occlusions using the CM stent retriever. Good capillary reperfusion (TICT≥2b) was observed in 32 out of 41 patients (78%). Focal ischemia within the territory vascularized by the artery addressed by the CM was observed in 8 patients (19.5%). Post-procedural vasospasm was observed in 8 patients, all responding rapidly to vasodilatator administration. Two asymptomatic hemorrhages (4.9%) were noted on follow-up imaging (one patechial hemorrhage and one parenchymal hematoma) in patients with M2 occlusions. No vessel rupture were observed. Overall, good neurological outcome at three months (mRS≤2) was observed in 28 (out of 34 patients followed; 82.4%) of patients.

Conclusions: Our single-center experience shows that the CM stent retriever is safe and effective for the recanalization of small diameter distal branches feeding eloquent brain areas.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.neurad.2018.01.051DOI Listing
September 2018

Outcome of transarterial treatment of dural arteriovenous fistulas with direct or indirect cortical venous drainage.

J Neurointerv Surg 2018 Oct 30;10(10):958-963. Epub 2018 Jan 30.

Service de neuroradiologie diagnostique et interventionnelle, Centre hospitalier universitaire de Montpellier, Hôpital Gui de Chauliac, Montpellier, France.

Background And Purpose: Transarterial Onyx embolization is an effective treatment for patients with intracranial dural arteriovenous fistula (DAVF). A study was performed to determine whether the clinical and radiological outcomes after transarterial Onyx treatment were affected by the type of cortical venous drainage (direct vs indirect) of high-grade DAVF.

Materials And Methods: Between May 2006 and December 2014, demographic data, clinical presentation, angiographic characteristics, and treatment-related outcomes were collected for 54 patients divided into two groups (intracranial DAVF with direct and indirect cortical venous drainage). Continuous variables were compared with the two-tailed t test and categorical variables with the χ test. Statistical significance was set at P<0.05.

Results: Fifty-two patients (71% with direct and 29% with indirect cortical venous drainage) underwent Onyx embolization. Immediate complete occlusion after treatment was observed in about 55% of patients without between-group difference. During the long-term follow-up, complete angiographic occlusion was achieved in 83% of patients. Specifically, 15 additional patients (40%) in the direct cortical venous drainage group progressed to complete occlusion, but only one (6%) in the indirect cortical venous drainage group. Overall, the rate of complete occlusion was higher in patients with DAVF with direct cortical venous drainage (92%) than in those with DAVF with indirect cortical venous drainage (62.5%) (P=0.01). The rate of permanent treatment-related complications was 4%, mostly related to ischemic events. Overall, 80.5% of patients had a good neurological outcome (modified Rankin Scale score 0-2).

Conclusions: Transarterial Onyx embolization of intracranial high-grade DAVF is safe and effective, particularly for lesions with direct cortical venous drainage.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/neurintsurg-2017-013476DOI Listing
October 2018

Hemodynamics of Focal Versus Global Growth of Small Cerebral Aneurysms.

Clin Neuroradiol 2019 Jun 5;29(2):285-293. Epub 2017 Dec 5.

Neuroradiology Division, Department of Radiology and Medical Informatics, Geneva University Hospitals, Geneva, Switzerland.

Background And Purpose: Hemodynamics play a driving role in the life cycle of brain aneurysms from initiation through growth until eventual rupture. The specific factors behind aneurysm growth, especially in small aneurysms, are not well elucidated. The goal of this study was to differentiate focal versus general growth and to analyze the hemodynamic microenvironment at the sites of enlargement in small cerebral aneurysms.

Materials And Methods: Small aneurysms showing growth during follow-up were identified from our prospective aneurysm database. Three dimensional rotational angiography (3DRA) studies before and after morphology changes were available for all aneurysms included in the study, allowing for detailed shape and computational fluid dynamic (CFD) based hemodynamic analysis. Six patients fulfilled the inclusion criteria.

Results: Two different types of change were observed: focal growth, with bleb or blister formation in three, and global aneurysm enlargement accompanied by neck broadening in other three patients. Areas of focal growth showed low shear conditions with increased oscillations at the site of growth (a low wall shear stress [WSS] and high oscillatory shear index [OSI]). Global aneurysm enlargement was associated with increased WSS coupled with a high spatial wall shear stress gradient (WSSG).

Conclusion: For different aneurysm growth types, distinctive hemodynamic microenvironment may be responsible and temporal-spatial changes of the pathologic WSS would have the inciting effect. We suggest the distinction of focal and global growth types in future hemodynamic and histological studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00062-017-0640-6DOI Listing
June 2019

Safety and effectiveness of the Low Profile Visualized Intraluminal Support (LVIS and LVIS Jr) devices in the endovascular treatment of intracranial aneurysms: results of the TRAIL multicenter observational study.

J Neurointerv Surg 2018 Jul 24;10(7):675-681. Epub 2017 Nov 24.

Department of Interventional Neuroradiology, CHU-Limoges Dupuytren University Hospital, Limoges, France.

Background And Purpose: To evaluate the safety and effectiveness of the low-profile braided intracranial stents called the Low Profile Visualized Intraluminal Support (LVIS) devices for stent-assisted coil embolization of wide-necked intracranial aneurysms.

Materials And Methods: This was a prospective, multicenter, observational study of unruptured and ruptured intracranial aneurysms treated with the LVIS devices. Imaging and clinical data were independently analyzed respectively by CoreLab and Clinical Event Committee. Primary endpoints were clinical safety, effectiveness, and angiographic stability of the results at 6 and 18 months.

Results: Ten centers participated in the study; 102 patients were included and 90 patients (42.2% men, 57.8% women) were eventually analyzed, among which 27 (30.0%) had multiple aneurysms. Twenty-three (25.6%) were ruptured aneurysms, four of which (4.4%) were treated in the acute phase. One aneurysm was treated per patient; 92 LVIS and LVIS Jr devices were placed overall. The total aneurysm occlusion rate was 91.0% on immediate post-procedure angiograms, which remained unchanged at 6-month follow-up and was 92.4% at 18-month follow-up. One patient (1.1%) underwent retreatment between 6 and 18 months of follow-up. A modified Rankin score of 0 was documented for most cases immediately after the procedure (86.7%) and at 6-month (86.8%) and 18-month (83.3%) follow-up. The overall permanent morbidity rate at 18 months was 5.6% and the overall rate of events with sequelae related to the stent was 2.2%. The 18-month procedure-related mortality rate was 3.3%. No patient was deemed to require retreatment at 18-month follow-up.

Conclusion: The LVIS/LVIS Jr endovascular devices are safe and effective in the treatment of ruptured and unruptured intracranial aneurysms, with acceptable complication rates, very high immediate total occlusion rates, and stable angiographic results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/neurintsurg-2017-013375DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6031274PMC
July 2018

CT imaging selection in acute stroke.

Eur J Radiol 2017 Nov 26;96:153-161. Epub 2016 Oct 26.

Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland. Electronic address:

Acute stroke has become an increasingly treatable cause of acute neurological deficits. Indeed, over the last two decades, the introduction of first thrombolysis, and now thrombectomy has improved patient outcomes and extended the therapeutic window. Computed tomography has been established as the most simple and readily available technique for the diagnosis and management of patients with acute stroke. Indeed, CT allows easy confirmation or exclusion of acute hemorrhage on the one hand, and on the other hand the early signs are quite reliable in the detection of ischemia. In the early phase the clot can be seen as well as exchanges related to early changes in water concentration in ischemia and the surrounding penumbra. Additional techniques such as angio-CT show the location of the clot and perfusion techniques reveal local hemodynamics as well as potential tissue viability. Newer techniques such as double energy CT and late phase CT should provide information on collateral flow as well as on the presence of early hemorrhagic transformation. All these techniques should thus make available new information on tissue viability,that is indispensable in the choice of revascularization technique. Thus CT techniques allow a quick and reliable triage as well as a finer characterization of the ischemic process. The use of all these CT techniques in an optimal way should help improve patient triage and selection of the most adequate treatment with further improvements in clinical outcomes as a result.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejrad.2016.10.026DOI Listing
November 2017